In 2017, a survey by the Mental Health Foundation found that only a small minority of people (13%) reported living with high levels of good mental health, and nearly two-thirds of people said that they had experienced a mental health problem.

Prescribed medication is one response to mental health problems, and it’s been reported that the NHS is prescribing record numbers of antidepressants. But while psychiatric drugs can be of real value to patients, especially those whose condition is very severe, the mental health charity Mind has suggested that alternatives, such as physical exercise, talking therapies and arts therapies, are often more beneficial.

Last month, a conference at the University of Glasgow explored ways in which creative writing is being used to respond to mental ill health, and discussed what makes writing interventions helpful for coping and recovery.

Several speakers at the Glasgow conference testified to the effectiveness of writing in dealing with mental ill health and in finding a way to recovery.

In 2012, James Withey experienced a set of circumstances which brought him close to taking his own life. In the darkness of his depression, James felt that he might never recover. But after spending time at Maytree, the UK’s first “sanctuary for the suicidal”, he found that writing about what he was going through offered an antidote to the lies being spun by his depression.

He started a blog, and when he posted a letter to himself, beginning “Dear You.” James found that writing the letter gave him space to express his feelings and to listen to himself.

Before long, readers of James’s blog were responding with their own “Dear You” letters. The word spread that the letters offered a different perspective on recovery, and in some instances, had prevented suicide.

Today, The Recovery Letters project is still going strong, with a website, one published book and another in the pipeline. James is realistic about the project:

“The letters are not a cure for a chronic illness, but they do provide support in helping sufferers of depression accept where they are.”

Another speaker at the conference was Frances Williams, a PhD candidate at Manchester Metropolitan University, where she is studying arts and health. In her presentation, Frances explored some of the policy frameworks and public discourse surrounding the field of therapeutic writing in Wales.

She highlighted a recent report, Creative Health, The Arts, Health and Well-being, which makes a case for the healing power of the arts in many different healthcare and community contexts. In this report, a creative writing tutor explained some of the ways in which writing can help people experiencing bereavement, including keeping a journal, writing unsent letters, describing personal belongings and resolving unfinished conversations:

“Writing can be a valuable means of self-help, with the page as a listening friend, available any time of the day or night, hearing whatever the writer wants to say. The results of this can be powerful, and include people being able to return to work and adjust more effectively after their loss, acquiring skills for their own self-care which will serve them through the rest of their life.”

Frances also noted that the battle of priorities between impact and value-for-money has driven advocates of arts therapy programmes to defend them in terms of cost effectiveness and social value.

A mapping project by the Arts Council of Wales has taken this to heart, producing in 2018 an audit of the principal arts and health activities currently taking place in Wales.

Writing to the rescue

“By writing, I rescue myself”
William Carlos Williams

The Glasgow University conference underlined the health-giving properties of creative activities and the potential for creative writing to support people suffering with mental ill health. There was no pretence that writing offers a quick-fix solution. As James Withey noted, “…writing is just one element in a toolkit of responses to mental ill health.”

The All-Party Parliamentary Group on Arts, Health and Wellbeing fully supports this concept, and has recommended that policymakers recognise its importance:

“…the arts can make an invaluable contribution to a healthy and health-creating society. They offer a potential resource that should be embraced in health and social care systems which are under great pressure and in need of fresh thinking and cost-effective methods. Policy should work towards creative activity being part of all our lives.”

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As we head towards Christmas, the media is filled with images of families coming together and enjoying the festivities. However, the reality is that many people will not be spending the Christmas period with loved ones, and will be spending the festive season alone.

In April, Future Cities Catapult produced a report into the impact of social isolation and loneliness. They highlight that those experiencing social isolation and loneliness have an increased likelihood of developing health conditions such as dementia (1.9 times more likely) and depression (3.4 times more likely). In addition, there is a 26% increased risk of mortality.

The report also included findings from the Mormont Review, highlighting that in emergency situations social networks have a significant impact on recovery.

“Individuals who are socially isolated are between two and five times more likely than those who have strong social ties to die prematurely. Social networks have a larger impact on the risk of mortality than on the risk of developing disease, in the sense it is not so much that social networks stop you from getting ill, but that they help you to recover when you get ill.”

It’s this substantial impact on people lives’ – and the costs to the health service – which has led to many public bodies looking for ways to tackle social isolation and loneliness.

Technology-based interventions, in particular, are some of the most innovative approaches to addressing the issue that affects over half of all people aged 75 and over who live alone, as well as increasing numbers of young people. Below we’ve outlined some of the most interesting examples.

CogniWin

CogniWin provides support and motivation for older people to stay active and in employment by providing smart assistance and well-being guidance. It helps people to adapt cognitively with their work tasks through their interactions with a system (which collects information using an intelligent mouse and eye tracking software). A virtual Adaptive Support and Learning Assistant then provides feedback, which helps the older person adapt their working lifestyle or have the confidence to take up a part-time job or become a volunteer.

Casserole Club

Casserole Club is a social enterprise that brings together people who enjoy cooking and who often share extra portions with those who may not be able to cook for themselves. Founded by FutureGov and designed in partnership with four local authorities, the service uses its website to allow volunteers to sign up and search for diners in their area (most of which, are over 80 years old). Overall, there are 4,000 cooks nationwide, and 80% of diners highlight that they wouldn’t have much social contact without the Casserole Club.

Family in Touch (FIT) Prototype

The Family in Touch (FIT) prototype was developed by a team of Canadian researchers who noticed that elderly people in care homes and retirement communities often touched photographs in an attempt to connect with family members. Based on this, the team created a touch screen photo frame which sent a message to a relative to say that they were thinking of them. The relative was then able to record a video message, which could be viewed by the elderly person in the photo frame. It was found that elderly people appreciated the simple design and tactile user experience.

Final thoughts

These are just some of the innovative tools being used to tackle social isolation and loneliness. And although technology is not the whole solution, it can certainly provide new opportunities for projects seeking to provide friendship and support to those who feel disconnected.

Individually, we can also make a difference. Even just making a phone call to an elderly relative, sending a message to an old friend, or visiting a neighbour, can brighten up someone’s day.

The Knowledge Exchange provides information services to local authorities, public agencies, research consultancies and commercial organisations across the UK. Follow us on Twitter to see what developments in policy and practice are interesting our research team.

In March 2017, the 20th Maggie’s Centre was opened in the grounds of Forth Valley Royal Hospital in Falkirk. Designed by architects Garbers & James, it is expected to receive 3000 visits in the first year.

Maggies Centre Forth Valley, Garbers and James

Maggie’s provides free practical, emotional and social support to people with cancer and their family and friends, following the ideas about cancer care originally laid out by Maggie Keswick Jencks and co-founded by her husband Charles, who is a landscape architect. Among Maggie’s beliefs about cancer treatment was the importance of environment to a person dealing with cancer.

She talked about the need for “thoughtful lighting, a view out to trees, birds and sky,” and the opportunity “to relax and talk away from home cares”. She talked about the need for a welcoming, reassuring space, as well as a place for privacy, where someone can take in information at their own pace. This is what Maggie’s centres today aspire to.

A number of high profile architects have designed Maggie’s Centres across the UK – from the late Zaha Hadid to Frank Gehry, Richard Rogers and Rem Koolhaas.

The Maggie’s Centre in Kirkcaldy, Zaha Hadid Architects

Promoting wellbeing through the natural environment and effective design

Drawing on research which considers the significant impact that environment can have on wellbeing, Maggie’s Centres are designed to be warm and communal, while at the same time being stimulating and inspiring. The interiors are comfortable and home-like. Landscape designers and architects are encouraged to work closely together from the beginning of a project as the interplay between outside and inside space, the built and the “natural” environment, is seen as an important one.

“A building, while not wholly capable of curing illness, can act as “a secondary therapy”, encouraging wellness, rehabilitation and inspiring strength from those who move around it.”

Each of the centres incorporates an open kitchenette where patients can gather for a cup of tea, airy sitting rooms with access to gardens and other landscape features, and bountiful views. There are also private rooms for one-on-one consultations; here Maggie’s staff can advise patients on a range of issues relating to their condition, whether that is dietary planning, discussing treatment options (in a non-clinical setting) or delivering classes such as yoga.

Spaces to promote mental wellbeing as well as physical healing

Maggie’s Centres are also about offering spaces to people to help improve their mental wellbeing. As well as quiet tranquil spaces for reflection and meditation, there are also central areas, focused on encouraging the creation of a community between the people who use the centre. Wide-open spaces, high ceilings and large windows, with lots of opportunities to view the outside landscaping and allow natural light to enter are a key feature of many of the Maggie’s Centres.

The locations also try as far as possible to provide a space free from noise and air pollution, while remaining close enough to oncology treatment centres to provide a localised base for the entire treatment plan of patients.

Fresh air, low levels of noise and exposure to sunlight and the natural environment, as well as designs that provide spaces that promote communal interaction to reduce feelings of isolation and loneliness, have all been shown to improve mental as well as physical wellbeing. In this way, the physical attributes and design of the Maggie’s buildings are helping to promote mental as well as physical wellbeing of patients and supplement the care being given by the cancer treatment centres located nearby.

A Maggie’s garden was also featured at the 2017 Chelsea Flower show, highlighting the importance of environment, and the role of the natural environment in rehabilitation and promoting wellness among those who are ill.

Final thoughts

How design and landscape can aid and empower patients is central to Maggie’s Centres. They are a prime example of how people can be encouraged to live and feel well through the design of buildings and the integration of the surrounding natural environment. These environments are the result of a complex set of natural and manmade factors, which interact with one another to promote a sense of wellness, strength and rehabilitation.

They demonstrate how the built environment can contribute to a holistic package of care – care for the whole person, not just their medical condition. Other health and social care providers can learn from them in terms of supporting the wellbeing of patients, carers and their families.

Our blog on the Men’s Sheds movement was one of our most popular last year. The movement originated in Victoria, Australia in the 1990s, as a place for men to socialise and take part in practical activities. 23 years later, there are now close to 1,000 such spaces in Australia. Sheds have also proven popular in Ireland (350 Sheds and counting) and Scotland (at least 38 up and running, with 30 in the start-up phase).

Research has indicated that loneliness and isolation are a particular issue for certain groups of men, which is reflected in higher suicide rates. Evaluations of Men’s Sheds have found participation to have a range of positive effects for these groups of men, predominantly in terms of their mental health and wellbeing.

The importance of Sheds not being regulated by outside agencies, e.g. government – this was something that those involved in Sheds felt particularly strong about. As noted by Professor Mike Osborne, the Director of CR&DALL, at the start of the afternoon, the reduction in government support for adult education has created a need for people to organise themselves in order to access lifelong learning opportunities. Thus, those who attend Sheds feel strongly about preserving the independence of the space, as well as its democratic dynamic.

How to ensure the sustainability of Sheds, and community projects in general – Willie described how the SMSA can support Sheds across Scotland by offering advice on applying for funding, how to keep things like rental costs low, and using mechanisms such as the Community Empowerment Bill and Community Asset Transfers to their advantage. Noting the difficulty that many community projects face in sustaining themselves long-term, Willie highlighted the Clydebank Independent Resource Centre (CIRC), which has been running for over 40 years, as a rare but good example of how sustainability can be achieved.

…and the big picture internationally

The second speaker of the day was Professor Barry Golding from Federation University Australia. Barry is the most prolific researcher in the area of Men’s Sheds, and published The Men’s Shed Movement: The Company of Men last year. Barry described the origins of the movement in Australia, and suggested it took off due to its provision of the three key things that men need: somewhere to go, something to do, and someone to talk to.

Barry also emphasised the importance of not formalising Men’s Sheds, and particularly not promoting the spaces as somewhere where men with health issues go (not a very attractive prospect to an outsider!) This point was also picked up by David Helmers, CEO of the Australian Men’s Shed’s Association. David described the experience of one Australian Shed who had a busload of patients arrive after being referred by health services. The point of the Shed is to create a third space for men (other than home or work) where they can relax and socialise with their peers. Any learning or health improvements that arise from this is coincidental and not forced.

Barry and David were followed by John Evoy of the International Men’s Shed Organisation (IMSO). John focused on the experience of Sheds in Ireland, noting the impact of the recession as a particular reason why the movement has taken off in Ireland. The IMSO’s aim is to support a million men through Sheds by 2022.

Strengthening the movement and using evidence

To finish the afternoon, two panels comprising Shed members and researchers considered the questions of how to strengthen and sustain the Men’s Sheds movement, and how research might be beneficial to this.

Shed members on the panel and in the audience suggested that changing the stereotype of Sheds as spaces for older men with health (particularly mental) issues is important. In fact, men of any age are welcome to attend their local Shed, and current members are particularly keen to encourage this in order to support the intergenerational transmission of practical skills that are otherwise at risk of being lost.

In terms of available evidence, it was noted that research on Men’s Sheds is still scarce, and focused on the Australian experience. Catherine Lido, a lecturer in psychology in the university’s School of Education, discussed the pros and cons of carrying out a systematic evaluation of the movement in the UK. Again, the importance of the democratic nature of Sheds was raised – allowing outside agencies, particularly government, to come in and carry out research would involve the loss of some control. Any research conducted would have to be participatory, in order that Shed members did not feel like they were the subject of an ‘experiment’. Barry Golding highlighted, however, that there is currently almost no data on UK Sheds available; rectifying this could strengthen Sheds’ chances of being successful in applications for funding to support their running costs.

If you enjoyed reading this, you may also be interested in our previous blog on ‘makerspaces‘, which have drawn comparisons with the Men’s Sheds movement.

Follow us on Twitter to see what developments in public and social policy are interesting our research team.

Promoting awareness of health and social issues among men, and particularly older men, has always been a tricky challenge. According to research, the longstanding stereotype of men who actively avoid visiting the doctor is true: significant numbers of older men may be experiencing loneliness and isolation due to their reluctance to join clubs for older people, a fact which may explain why suicide rates are higher among middle-aged and older (white) men.

One initiative that has tried to tackle this issue is the Men’s Sheds movement, which originated in Australia in the 1990s after concerns were raised over the lack of opportunities for older men to socialise and discuss any issues they were having with their peers. This led to the emergence of numerous Men’s Sheds across the country, in the form of workshops where men could come together to engage in traditional shed-orientated activities such as woodwork, as well as form new social connections and access health information.

The benefits of Men’s Sheds

Evaluations of Men’s Sheds have identified a range of benefits for the men who participate in them, as well as for the wider community. Older men and social activity: a scoping review of Men’s Sheds and other gendered interventions published in Ageing and Society in April 2015 identified a range of positive effects of the initiative on older men, particularly in terms of improvements in their mental health and wellbeing status. While limited evidence was found of a positive impact on the men’s physical health, the review did find that belonging to a Men’s Shed provided participants with both a personal and social sense of accomplishment – through learning and sharing skills and contributing to their local community – as well as a sense of purpose, through social engagement with their peers which enabled opportunities for fun and camaraderie.

Men’s Sheds in the UK

Between 2010 and 2012, Age UK ran a ‘Men in Sheds’ pilot project, initially limited to Kendal, Bildworth and South London. The popularity of the pilot saw it covered in the national press and other ‘Men in Sheds’ projects soon opened in other areas, with one participant expressing his regret that the initiative had not been established in his area years ago.

In 2013, the UK Men’s Sheds Association was launched. They provide information on how to start a new Men’s Shed, or develop an existing organisation, and have helped form regional networks of Sheds.

One of these networks is in Glasgow, which is now home to the Glasgow Area Men’s Sheds (GAMS) group. We spoke to current GAMS secretary Charlie, who became involved in Men’s Sheds after illness led to him experiencing unemployment and social isolation. After coming across the UK Men’s Sheds Association website, he met up with six other men who were also interested in starting a Shed in Glasgow. Fast forward a year, and there are now at least six separate Sheds in the Glasgow area, at which Charlie estimates there are around 80 regular attendees. For Charlie personally, involvement with Men’s Sheds has allowed him to “build a portfolio of work experience, gain possible references, meet new people, go to new places and do new things”.

Charlie also pointed to research published by the Joint Improvement Team (JIT) in February 2015 which highlights the rapid spread of Men’s Sheds throughout Scotland over the last two years, with Sheds now in 18 of the country’s 32 local authority areas. The report also looks at the development paths of Men’s Sheds, as well as drawing out lessons for other community capacity building initiatives and outlining the local and community support needed to develop a Shed.

What about the women!

According to GAMS, the question of why the Sheds are men-only affairs is a common one. Their response is that “Men’s Sheds address specifically male issues involving male social isolation, men’s health both physical and psychological, re-defining of masculinity in modern society […] women have much more and highly developed socialising group opportunities”.

“Loneliness and the feeling of being unwanted, is the most terrible poverty“– Mother Teresa

Yet, for many older people, loneliness and social isolation are the normal state of affairs. A recent study by the Office for National Statistics (ONS) found that 34% of people aged 52 and over felt lonely often or sometimes, with this figure reaching 46% for people aged 80 or over. Rather worryingly, a report by Age UK also suggested that over half of older people consider the television as their main source of company.

In many respects, these figures may not be too surprising, with some arguing that this is simply the by-product of changing societal attitudes. Conversely, it could also be said that these changes are a response to the demands of busy modern life. For example, a report published by the Royal Voluntary Service highlights that, because of uncertainty in the job market, many children have to move away from their parents for work reasons. The impact of this is that many older people are seeing their families less and less, with 48% of parents only seeing their children once every two to six months. Continue reading →